BUTTE-SILVER BOW PARKS AND RECREATION DEPARTMENT
1340 Harrison Ave
BUTTE, MT 59701
Pickleball Participation / Release Form
Please check appropriate session:
Pickleball_____ ($50 Fall Session, $50 Winter Session)
Pickleball_____ ($25/For Winter players who paid and played in the Fall session)
** Make checks payable to: BSB Parks & Rec Dept.**
Name: _________________________________________ Date: ______________________
Email: _________________________________________ Phone: _____________________
Anyone participating in a BSB Parks, and Recreation Program must print and sign their name. Participants must be at least 16 years of age. Players under the age of 18 must have a Parent / Guardian Signature on this release form.
I, the undersign, do hereby agree to accept complete responsibility in matter of any physical injury or loss that might result from participation in the games, practice, or travel to or from such activities. I further agree that in the event of such injury or loss that there shall be no liability on the part of Butte-Silver Bow, the Butte Plaza Mall or any group associated in the sponsorship of this activity.
Player’s Name Player, Parent, or Guardian Signature